Presented Wednesday, 05 September 2007 at the 29th Congress of the Societe International d'Urologie - SIU 2007 - Optimizing Clinical Outcomes in Prostate and Renal Cell Carcinomas - The Second Annual Symposium on Advanced GU Malignancy - Palais des Congres de Paris, France

Introduction: Cryoablation has increased in utilization as a primary prostate cancer therapy in the past several years. The objective of this report is to report the efficacy and morbidity of modern cryoablation in the community setting.

Methods: Since 2001 patients diagnosed with localized prostate cancer were offered cryoablation as a treatment option. All procedures were performed by a single urologist (DSE). Argon based cryoprobes were placed and operated to ensure that -40°C was achieved at the gland margin on two successive freeze thaw cycles. Patients returned every three months during the first year and every six months in subsequent years for follow-up including PSA, morbidity assessment and biopsy if their PSA was rising. Patients potent at the time of therapy were encouraged to try pharmaceutical ED therapies and to use vacuum ED therapy daily without a constriction ring. Potency was defined as being able to penetrate and complete intercourse with or without oral pharmaceutical assistance. Incontinence was defined as any leak of urine. Patients were stratified according to D'Amico 1998 risk group definitions and biochemical failure was defined as 3 rises with a final value >1.0 ng/ml.

Results: The average age of the 510 patients treated was 69.5±6.3 years. Pre treatment PSA was 8.6±8.4 ng/ml and median Gleason sum was 6 (range: 4-9). Patients were followed for 22.8±17.1 months with 29 having 5 years follow-up. Incontinence at 6 months was 3.9%. Of those patients potent at the time of therapy, 35.6, 43.8 and 50.0% were potent at 12, 24 and 36 months, respectively. No rectal fistulas occurred. Five-year actuarial biochemical of all patients was 72.6±2.7%. Stratified by risk group it was 78.2±4.3, 71.5±4.2 and 65.5±6.1% for low, moderate and high risk, respectively. The negative biopsy rate was 94.7%.

Conclusion: In a community setting cryoablation provides cancer control rates similar to other therapies with acceptable morbidity. Potency was higher than previous reports. This may be due to historical series involving mostly older men. Further, providing encouragement that impotence is not guaranteed along with post procedure vacuum therapy and the availability of oral pharmaceutical therapies may have resulted in the increase in post procedure potency. Further study is warranted.

Authors: Vestal J, Rewcastle J, Manny T, Ellis D

UroToday.com Full Conference Coverage

Please log-in or register in order to submit comments.

Powered by AkoComment!